REACH Registry Highlights That Patients With Peripheral Arterial Disease (PAD) Suffer High Rates of Heart Attack, Stroke, Hospitalization, and Death
VIENNA, Austria, September 05, 2007 /PRNewswire/ -- New analyses from the REACH Registry presented at the European Society of Cardiology Congress 2007 underscore the REACH Registry 1-year results first published in the Journal of the American Medical Association in March 2007. Outpatients with atherothrombosis have a surprisingly high risk of death or major cardiovascular illness, especially in the over 25 million patients internationally who have peripheral arterial disease (PAD), or atherothrombosis in the leg arteries.
Researchers evaluated the data from the Registry, which represents the largest international population with PAD ever studied. Patients with PAD suffer very high rates of heart attack, stroke or death, and very high rates of hospitalization. These data again highlight that establishing the PAD diagnosis identifies a very high risk which is known to improve when the diagnosis is linked to guideline-mandated risk reduction therapies. Lead author Dr. Alan T. Hirsch, professor of epidemiology and community health at the University of Minnesota School of Public Health; and director of the Minneapolis Heart Institute's vascular medicine program at Abbott Northwestern's Vascular Center in Minneapolis, Minn., presented the results today.
Dr. Hirsch noted, "PAD has long been known to represent a form of artery disease that carries a high risk. The international REACH Registry demonstrates that this cardiovascular risk in patients with PAD remains remarkable in every nation, and is undoubtedly associated with a high personal, family, community, and public health cost. One in three individuals with PAD in office practice face a short-term chance of dying, having a heart attack or stroke or being hospitalized within two years. One in ten will die in this short time frame. Therefore initiating therapy without delay to reduce this risk is essential."
Despite improved PAD awareness, treatment and diagnosis during the past five years, Hirsch and investigators hypothesized that cardiovascular disease event rates would remain high, and that complacency in treating this disease was not merited. The analysis of international individuals enrolled in REACH found this to be true. All individuals with PAD, regardless of symptom status or past use of leg angioplasty or leg bypass remained at high risk.
"The REACH Registry continues to demonstrate the real-world burden of atherothrombotic disease worldwide. In the case of PAD, further analysis has re-emphasized the need for doctors to adhere to evidence-based guidelines for treatment like long-term antiplatelet therapy with aspirin or clopidogrel," said Dr. Gabriel Steg, professor of cardiology at Hopital Bichat-Claude Bernard, Paris, on behalf of the REACH Registry's Scientific Council. "But first diagnosis must happen earlier and to do this the tools need to be more readily available and reimbursed, especially in Europe."
Details on Hirsch Analysis
Results: REACH enrolled 8581 individuals with PAD, by asymptomatic ABI<0.9 alone (8%); claudication (65%); prior limb revascularization (50%); or amputation (13%). Risk factors were prevalent (diabetes 44%, current smoking 24%, hypercholesterolemia 66%). Antiplatelet (81%), antihypertensive (87%), antidiabetic (40%), and lipid-lowering therapies (70%) were well-utilized. Non-fatal CV disease events and mortality remained high (Table). Leg angioplasty, vascular bypass, or amputation occurred at annual rates of 7.6%, 5.3%, and 2.8%, respectively.
In addition to the analysis on PAD, REACH investigators presented posters on other sub-analyses during the European Society of Cardiology Congress 2007:
-- "Cardiovascular events of Asian patients at high risk of atherothrombosis compared with the rest of the world: Results from the REduction of Atherothrombosis for Continued Health (REACH) Registry" S. Goto, Y. Ikeda, JCN. Chan, PWF. Wilson, R. Zambahari, T-C. Yeo, C-S. Liau, TB. Abola, PG. Steg, DL. Bhatt -- "International variation in the rates of vascular hospitalizations in patients at risk of atherothrombosis: Results from the REACH Registry for U.S., France, and Germany" E M. Mahoney, K. Wang, DJ. Cohen, F. Mosse, J. Jackson, DL. Bhatt, PG. Steg, G. De Pouvourville -- "Cardiovascular risk profile and outcome of patients with an abdominal aortic aneurysm in the REACH Registry" Baumgartner, AT. Hirsch, TB. Abola, PP. Cacoub, D. Poldermans, PG. Steg, MA. Creager, K. Eagle, DL. Bhatt
Objectives and Scope of REACH
The overall aim of the REACH Registry is to improve the assessment and management of stroke, heart attack and associated risk factors for atherothrombosis. It is the largest and most geographically extensive global registry of patients at risk of atherothrombosis, having recruited over 68,000 patients in 44 countries, covering six regions - Latin America, Asia, the Middle East, Australia, Europe and North America - and involving over 5,000 physician investigators.
The REACH Registry includes a broad spectrum of patients with atherothrombosis - documenting the health status and treatment of people at risk of atherothrombosis; monitoring how they are affected; and measuring the burden of the disease. Patients included in the REACH Registry either have several of the risk factors that can lead to atherothrombosis, such as, high cholesterol, high blood pressure, smoking, and diabetes, or have a previous history of heart attack, stroke or PAD. Participation in the REACH Registry is strictly voluntary.
In addition, the REACH Registry is based in a real-life setting and seeks to increase overall understanding of atherothrombotic disease across several medical specialities (cardiology, neurology, internal medicine, vascular medicine and office-based primary care physicians), which allows for a more thorough assessment of the real-world burden of the disease.
The Underlying Cause of Heart Attack, Stroke and PAD
Atherothrombosis occurs when a blood clot (thrombus) forms on a ruptured plaque (atheroma) in the wall of a blood vessel. Plaques consist of fatty acids and cholesterol, calcium and other materials.
The rupture of plaques and the subsequent development of a clot can cause partial or complete blockage of an artery in various parts of the body. When a vessel in the heart is partially or completely blocked by a clot the result can be a heart attack. In the brain, the same process can cause a stroke. Elsewhere in the body, this process can lead to reduction or blockage of blood flow in the arteries of the legs - PAD - a significant risk factor for heart attack or stroke.
Atherothrombosis is thus the common thread linking heart attack, stroke and peripheral arterial disease.
Notes to Editors:
The REACH Registry is the first outpatient registry to characterize real- world event rates and treatment patterns in a broad spectrum of patients with atherothrombosis worldwide. The Registry follows more than 60,000 patients over 4 years, involving 44 countries and 5,000 physician investigators. The REACH Registry aims to improve the assessment and management of patients with a history of coronary artery disease (CAD), cerebrovascular disease (Stroke/TIA), peripheral arterial disease (PAD), and those with a combination of high risk factors.
The REACH Registry is sponsored by Sanofi-Aventis, Bristol-Myers Squibb, and the Waksman Foundation (Tokyo, Japan), who assisted with the design and conduct of the study and data collection.
The REACH Registry is endorsed by the World Heart Federation.
REACH Registry Baseline Publication:
DL. Bhatt, PG. Steg, EM. Ohman, AT. Hirsch, Y. Ikeda, JL. Mas, S. Goto, C- S. Liau, AJ. Richard, J. Rother, PWF. Wilson, on behalf of the REACH Registry Investigators. International Prevalence, Recognition, and Treatment of Cardiovascular Risk Factors in Outpatients with Atherothrombosis. JAMA 2006;295:180-9.
REACH Registry Scientific Council: -- Philippe Gabriel Steg, AP-HP, Hopital Bichat-Claude Bernard, Paris, France (co-chair) -- Deepak L. Bhatt, Cleveland Clinic, Cleveland, USA (co-chair) -- E. Magnus Ohman, Duke University, Durham, USA -- Joachim Rother, Universitat-Klinikum Minden, Minden, Germany -- Peter F. Wilson, Medical University of South Carolina, Charleston, USA
For further information on the REACH Registry please visit www.REACHRegistry.org
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Posted: September 2007